Ageing Eyes: Recognizing the 10 Warning Signs

Our eye structure and functions begin to deteriorate at the age of 40—a natural process called ageing eyes that affects our ability to see (vision). According to a census conducted by the Department of Statistics Malaysia, around 413,000 Malaysians aged 50 and above had visual impairment.

Most age-related eye conditions are fairly normal and can be treated with artificial tear drops, speciality glasses, or laser surgery to correct impaired vision.

However, some chronic eye diseases have no cure and cannot restore vision loss. Treatments for these cases are limited to ways of slowing down progression only.

Warning Signs of Ageing Eyes

Determining sight-threatening signs before it is too late can make a huge difference in saving your vision as much as possible.

Vision loss

Ageing adults experience different degrees of vision loss, usually affected by various eye conditions:

• Loss of central vision (a symptom of AMD)
• Loss of side or peripheral vision (a symptom of glaucoma)
• Cloudy and hazy vision (a symptom of cataracts)
• Blurry vision of near objects, or presbyopia
• Low vision

Low vision is when your impaired vision can no longer be reversed or fixed with usual treatments like prescription glasses, contact lenses, surgery, and medications. It can be caused by either AMD, glaucoma, or diabetic retinopathy.

Eye pain

Any pain within or around the eye area should call for immediate treatment to the eye clinic. It may indicate high pressure in the eye due to serious conditions like glaucoma. If the pain is experienced together with the following symptoms, that signals an emergency:

• Headache
• Nausea
• Vomiting
• Sudden blurry vision
• Sudden sensitive to light

Avoid covering or pressing your affected eye prior to treatment, as this can worsen the pressure.

Difficulty adapting to light changes

Do you know how our eyes are able to transition from well-lit rooms to dark spaces and vice versa, without causing us headaches? That is the work of our irises.

The iris refers to the coloured part of our eye, which some are born with in brown, blue, or green. It contains muscles that control the amount of light entering the pupil (the dark circle in the middle of your eye lens). These muscles contract in bright surroundings to allow less light in, and expand in darker surroundings to let more light in.

Just like the rest of our body muscles, iris muscles also get weaker with age. As a result, the pupil has a slower response to brightness and darkness, which causes ageing eyes to take longer time when adapting to light changes.

This complication can trigger dizziness or headaches and make driving in tunnels more dangerous—increasing the risks of falls and accidents. 

Poor night vision

While the iris and pupil are important in light adjustment into the eye, the components that provide us with the ability to see in different levels of light are rod cells and cone cells.

Each of these photoreceptor cells has distinct functions:

• Rods – Very sensitive to light, which is useful for lower light levels (e.g night time)
• Cones – Allows us to perceive colours, which is more useful in higher light levels (e.g daytime)

Research concluded that we lose rod cells faster than cone cells as we grow older, which contributes to unclear vision in dark or dim-lit environments. Cloudy lens due to cataracts is another reason why older adults have difficulty driving and reading at night.

Eye floaters and flashes

If you see shadows of tiny lines, spots, or irregular shapes floating in your vision and moving around as your eyes move—these are eye floaters.

The eyeball is filled with jelly-like fluid called the vitreous humour. As we age, the jelly shrinks and becomes more watery. This allows fibres inside the vitreous to float around easily, pushing them to stick together. 

Eye floaters are actually a sign of ageing eyes, and you eventually get used to it after a while. They can appear even at a young age especially those with nearsightedness.

However, it can also be abnormal if you start seeing more floaters than usual, or it appears with flashes of light (after rubbing your eyes too hard). These may be a sign of torn retina or diabetic retinopathy, which can lead to permanent vision loss if untreated.

Double vision (Diplopia)

Seeing two images of the same object may be normal if you just started wearing spectacles for the first time or getting a new lens. Usually, this lasts temporarily. However, the consistent double vision among the elderly can mean entirely something else, either cataracts or underlying serious health conditions such as stroke.

Various factors can be attributed to double vision such as problems with the cornea, lens, eye muscle, or impairment in the nerve or brain. You may experience double vision in one eye only (monocular diplopia), or in both eyes (binocular diplopia).

Difficulty to see sharply

Contrast sensitivity allows us to recognise the outlines of an object sharply, without any blurriness fading into the background. This ability makes driving at night and in a fog much safer as we can make out the shape of cars on the road. It also prevents us from having to squint our eyes in front of the screen to get a clearer view.

Having reduced contrast sensitivity means you struggle to differentiate objects from similar-coloured backgrounds or in low light. For example, the elderly from the age of 71 may not be able to notice a white vase in front of a white wall as the colours seem to blend in together, making the vase seemingly disappear.

Dry eyes

Dry eye syndrome (DES) is a common condition, especially for older adults above 50 years old.

Ageing causes the lacrimal glands in our eyes to produce fewer tears. Certain medications like drugs for hypertension and Parkinson’s disease are known to cause dry eyes as a side effect. Hormonal changes in menopause may affect the tear production as well.

The lack of moisture not only leaves the surface of our eyes dry, but it also makes it harder to flush out dust and dirt caught from the environment. Your eyes can get really uncomfortable due to itchiness, redness, and burning sensation. This leads to constant rubbing or touching of the eye area, which can increase the risk of infection.

Distorted vision

The fluid leak or bleeding in the retina caused by AMD can create distorted images. For example, you may see straight lines appear as wavy or bent, and objects seem out of shape. Because of this, seniors with AMD are prone to dizziness and headaches.

A common way to diagnose AMD or other alterations in vision is by using a testing tool called Amsler Grid, which displays horizontal and vertical lines on a grid.

Eyelids problems

The ageing process on your eyelids is more than just a decline in appearance like fine lines and wrinkles. Apart from eye problems, your eyelids can experience a condition called blepharitis due to meibomian gland dysfunction (MGD).

Meibomian glands are located at the edges of your upper and lower eyelids. They produce oil to seal and lock the tears, so that your eyes would not dry out quickly. As you get older, the glands are not working properly which may trap oils along your eyelids and become clogged, causing inflammation. Adding to this, your eyelashes can collect these excess oils together with bacteria and develop crusts.

As blepharitis usually happens repeatedly, the key is to apply warm compress and gently wipe the crusts off your eyelids regularly.

Other age-related eyelids issues may involve drooping or sagging of eyelids (ptosis) and lower eyelids turning outward (ectropion) or inward (entropion).

This article is an adaptation of Ageing Eyes: Spot the 10 Warning Signs from Homage.my.

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